Care Home: Meadow`s Court

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What the care home does well People are very satisfied with the care that they receive from staff and their personal and health care needs are well met; " I`m more than satisfied with my care here.", "The staff are very good, always helpful." "I feel that my care needs are met. If I need a doctor or anything like that it is always arranged." Systems for storing and administering medication are also well organised. There is good formal and informal communication between the service and the people that live at Meadow`s Court. Regular residents` meetings are held and people have the opportunity here and in formal surveys to express their concerns and put forward ideas for change. People are positive about their relationships with key workers (staff members who are responsible for particular aspects of their care) "My key worker is very good", "I have an excellent key worker who helps me with all my needs." People are also very positive about the food, "The food here is always good", "I enjoy the food, it`s well cooked" and provision is made for people with special dietary needs. People have the opportunity to take part in activities during weekdays and there is a special activities room and an activities organiser. People also commented positively on the way their clothes were taken care of, "We`ve got two lovely laundry ladies here the clothes come back lovely." What has improved since the last inspection? No requirements or recommendations were made at the previous key inspection What the care home could do better: No requirements or recommendations have been made at this inspection Inspecting for better lives Key inspection report Care homes for older people Name: Address: Meadow`s Court Old Church Street Aylestone Leicester Leicestershire LE2 8ND     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Ruth Wood     Date: 1 3 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2010) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Meadow`s Court Old Church Street Aylestone Leicester Leicestershire LE2 8ND 01162248888 01162248888 meadows@hicare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : HiCare Limited care home 66 Number of places (if applicable): Under 65 Over 65 66 66 66 65 2 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability sensory impairment Additional conditions: 66 66 0 65 2 Meadow`s Court is registered to provide personal care for male and female residents in the following categories: Old age not falling within any other category (OP) 66, Sensory Impairment over 65 years of age (SI(E)) 2, Sensory Impairment (SI) 2, Dementia over 65 years of age (DE(E)), Dementia (DE) 66, Mential disorder excluding learning disability or dementia over 65 years of age (MD(E)) 66, Mental disorder excluding learning disability or dementia (MD) 66, Physical disability over 65 years of age (PD(E)) 65, Physical disability (PD) 65 No person falling within the category DE between 40 and 54 years of age may be admitted when 11 people within this category and age group already reside at the home. No person falling within the category MD between 40 and 54 years of age may be Care Homes for Older People Page 4 of 26 admitted when 11 people within this category and age group already reside at the home. No person falling within the category PD between 40 and 54 years of age may be admitted when 11 people within this category and age group already reside at the home. No persons falling within the category SI(E) or SI can be accommodated at Meadow`s Court when 2 persons who fall within these categories/combined categories are already residing at the home. No persons under 40 years of age, falling within categories SI, MD, DE or PD may be admitted to the home. No service user within the category PD or PD(E) may be admitted to room 9. Date of last inspection Brief description of the care home Meadows Court Residential Home is registered to provide care for up to 66 people with a range of needs. The home is situated in a quiet residential area of old Aylestone village. It is a short walk away from a main road and bus routes in and out of the city centre. Peoples rooms are situated on both the ground and first floors. A choice of lounges and dining rooms is available. All areas of the home are accessible. There is a pleasant landscaped garden to the rear of the building with aviary, pond and seating. Further information about the home is available in the Service User Guide and Statement of Purpose or from the provider website www.hicare.co.uk At the time of the inspection visit fees were £475 per week. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The previous key inspection of this service was on 15/05/07 This inspection visit took place on a weekday between 10:00 and 17:30. We looked in detail at the care and support received by four people. This involved looking at their care plans, speaking to staff about how they delivered that care and speaking directly to two of the people concerned. We directly observed some care practices, such as the administration of medication and the serving of lunch. We looked at the systems in place for managing and administering medication and the training that staff have received in this area, as well as the other training they receive to do their jobs. We spoke to four staff about their experiences of training and Care Homes for Older People Page 6 of 26 supervision and looked at the recruitment records of three staff, recently employed by the service. We also looked at records relating to fire safety. We spoke to seven people about their general impressions of living in the home and one of their relatives about their opinion of the service. In addition to the inspection visit, this report has been informed by the following: The Annual Quality Assurance Assessment (AQAA) completed by the provider. This informs the Commission how the home has maintained and improved the quality of its service in the preceding year. The document also gives us some statistical information about the home. Nine responses to ten surveys issued by the Commission, asking people about their experiences of living in the home. Four responses to five surveys sent to staff asking about their experiences of recruitment, supervision and training. Information from the service about incidents that have taken place at the home, which impact on the wellbeing of one or more of the people living there. These are called notifications. A random inspection of the service on 09/07/2008, which looked at aspects of care practice and staff recruitment. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Effective assessment practices ensure that peoples needs are identified before they move into the home. Evidence: The Statement of Purpose and Service User Guide are displayed in the entrance area and contain accurate information about the service. Everyone in the home is given their own copy. Both documents can be provided in other languages if required. Of the nine people who responded to the Commissions survey, six said that they had received enough information about the home and one said that they hadnt. Two people replied dont know to this question. People spoken with on the day of the inspection said that either they or their families had come to look around the home before they moved in and several people had used the service for short visits before they made the decision to move in permanently. The service routinely offers people the opportunity to spend a day, without charge, to try the service to help people make Care Homes for Older People Page 10 of 26 Evidence: an informed decision about living there. Assessments are in place for the four people whose care that we looked at in detail. The deputy manager usually visits a prospective resident in their existing setting to undertake the assessment. Social work assessments are also in place for those people funded by the local authority. The service undertakes an annual assessment review of all privately funded people who are not reviewed by social services. Meadows Court does not provide Intermediate Care Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are met and they are treated with dignity and respect. Evidence: The service intends to update the care plans of all the people living in the home so that they contain more detail about the persons needs and how they should be met. The new care plan format was in place for one of the people whose care we looked at in detail. It outlines clear and detailed information about how each aspect of their needs should be met, including details about how to effectively communicate with the person. The registered manager said that although she and staff could explain the needsof all the people living in the home, and how they are met, the current care plans did not express this as clearly and in as much detail as the new format. Seven of the nine people who responded to our survey said that they always received the care and support they needed, one person said that they usually did and one that they sometimes did. We spoke to two of the people whose care that we looked at in Care Homes for Older People Page 12 of 26 Evidence: detail and they said that staff met their needs and were complimentary about their keyworkers, X is my keyworker, he is very good, Im very satisfied with my care here. The relative that we spoke with was also complimentary about the standard of care, The care is first class for my Dad. Peoples health care needs are met and details of health care appointments are recorded in peoples files. People that we spoke to confirmed that they had regular optician and chiropody appointments and that ongoing health conditions, such as diabetes were regularly monitored by outside professionals. Other health professionals are involved in peoples care when required; during the inspection visit one person received a visit from a physiotherapist and an appointment for another person was made to see the dentist. Staff members have received or are receiving training in understanding diabetes and in pressure area care. Senior staff members have been trained to administer insulin and monitor blood glucose levels. We recommended that the optimum blood glucose range for each person, together with the action to be taken should levels fall outside this range should be documented as part of peoples care plans. We received evidence that this had been put in place immediately after the inspection visit. We examined all aspects of medication storage and recording and directly observed the administration of medication at lunchtime. The medication room was exceptionally clean and tidy and a weekly audit is carried out by senior staff to ensure that all aspects of medication management are complied with. Correct storage is in place for all medication and Medication Administration Records (MAR) are fully completed and accurate; this includes those dealing with controlled medication. Only senior staff administer medication and administration is carried out by two people. All senior staff have completed or are undertaking an extended distance learning course in medication administration. The staff administering medication on the day of the inspection were thorough and knowledgeable and no errors of administration practice were observed. The staff demonstrated a good understanding as to the circumstances under which some people would receive as required medication to manage some aspects of their behaviour. It was recommended that this information be written down and placed on the persons care plan and on the MAR. We received evidence that this had been put in place immediately after the inspection visit. We observed that people were treated with dignity and respect at all times during the inspection visit, with staff taking time to speak to people and giving them the time to respond. We did not observe people exhibiting any signs of distress during the visit. All the people who responded to the service said that staff listened to them and acted on what they said. One person commented, There is always someone there if I need help Care Homes for Older People Page 13 of 26 Evidence: and I like it here. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements for daily life and social activities are well managed and meet peoples expectations. People enjoy good food in pleasant surroundings. Evidence: We spoke to seven people about what they do in the home and their daily routine. People said that they generally could get up and go to bed when they liked, with some people saying that they usually came down early to get a cup of tea, which they took back to bed. Information about the days activities is displayed in the entrance to the home and in the activities room. This is located on the first floor and contains a large, wide screen television, a Wii game, puzzles, arts and crafts materials and a sensory stimulation unit. There is a part-time activities coordinator who works between Monday and Friday. People living in the home are aware of the activities on offer, such as exercises sessions, arts and crafts and games; on the morning of the inspection several people were in the activities room watching a Carry On film. Some people felt that these sorts of activities were not for them, The activities room upstairs is not my cup of tea - it is nice up there though. The activities coordinator recognises that some people do not like to venture upstairs and will paint peoples nails or encourage people Care Homes for Older People Page 15 of 26 Evidence: to join in listening to music in other areas of the home. People also spoke about day trips that take place during the warmer weather. Relatives are encouraged to feel part of the home, are free to visit at any time and are kept informed about developments in their relatives lives. One relative who spoke to us said, The staff are lovely and welcoming, if anything happens they phone you straight away. People were complimentary about the food served in the home, You couldnt get better food. I enjoy the food, its well cooked and very enjoyable., The food is alright, a lot of it is how I would cook it at home. There is a choice of two dining rooms or people can choose to eat in their own room; menus are placed on the table and there is always a choice of main course and pudding for lunch and tea. One person confirmed that there was always plenty of choice available, If theres nothing on the menu that I like then Ill have a jacket potato or theyll make me something else. The service ensures that people receive adequate hydration by asking people daily if they would like a jug of water, orange or blackcurrant juice in their room. One person confirmed that this is refilled every day, or as often as you like. Peoples specific dietary needs are outlined in the medication room and in the kitchen. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples concerns are listened to and they are protected by the procedures and practice in place. Evidence: All nine people who responded to our survey said that staff always or usually listen and act on what they say and that there was someone who they could speak with informally if they werent happy. Seven people said that they knew how to make a formal complaint, two said that they didnt. Regular residents meetings are held at the home and these offer an additional forum for people to express their views and air their concerns. All complaints are formally recorded and the service informs the Commission of complaints received and the response it has made. One person living in the home said, Every complaint is written down with the action taken. Staff receive in-house training on protection of vulnerable adults, one staff member we spoke to said that they had watched a video about abuse in care homes and were aware of their responsibilities to protect people. The four staff who responded to the Commissions survey said that they knew what to do if someone had concerns about the home and the four staff spoken with demonstrated understanding in this area of practice. The deputy manager has attended an alerters course in safeguarding vulnerable adults provided by the local authority and the registered manager said that she would also attend this training. Care Homes for Older People Page 17 of 26 Care Homes for Older People Page 18 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean and comfortable environment which meets their needs. Evidence: We looked at some of the communal areas of the home and one persons bedroom. The areas of the home that we saw appeared clean and comfortable and people that we spoke with expressed their satisfaction with the environment. The nine people who responded to our survey said that the home was always or usually fresh and clean. Staff confirmed that they have received training in infection control. The registered manager told us that all carpets in the communal areas are due to be replaced and that there are additional plans to extend the kitchen and dining areas of the home. The manager confirmed that the Commission would be informed in writing when these plans are to be implemented. The Local Authority Environmental Health Officer visited the service on 13/08/08 and stated that there were good standards of hygiene in place. Recommendations made at the time of this visit have now been met. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for by trained, competent staff Evidence: A random inspection was made to the service on 09/07/08 following concerns raised with the Commission. At this visit the recruitment records of six staff were checked. Staffs names had been checked against the Vulnerable Adults Register and references had been obtained, before they started work in the home. Criminal Records Bureau (CRB) checks had been applied for and staff fully supervised until these were received. We recommended that information about checks against the Register and CRBs be kept in a format which allowed the Commission to easily verify this. This information was easily accessible at this inspection visit and appropriate recruitment checks had been carried out on the three recently employed staff records that we sampled. The four staff members who responded to our survey confirmed that recruitment checks had taken place before they started work and that their induction covered well what they need to know about the job when they started. We spoke to the senior staff member responsible for staff training who said that there was a current programme to bring staffs training up to date. Staff confirmed that they were currently undertaking in-house dementia care training which involved reading several booklets about various aspects of dementia care, completing questionnaires Care Homes for Older People Page 20 of 26 Evidence: and one to one supervision sessions to check their understanding. Staff also said that they were undertaking pressure area care training using the same model of training. The registered manager said that 50 of staff had obtained a National Vocational Qualification in Care at level 2 or above and that remaining staff were seeking to register and complete these courses but that the service was experiencing some difficulties in obtaining appropriate assessors. Of the nine people living in the home who responded to our survey, five said that there were always staff available when they needed them and four said that there usually were. People made positive comments about the staff team during the inspection visit, The staff are very good., The staff are fine, Im well looked after. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well run home. Peoples views inform how the service is run. Evidence: The registered manager holds a National Vocational Qualification in Care at level 2 and at level 4 in Management. She has attended information sessions on the implementation of the Mental Capacity Act and the Deprivation of Liberty Standards. People living and working in the home spoke positively about the manager, and staff confirmed that they receive regular supervision and support. Good systems are in place to find out peoples opinions about the quality of the service. Regular residents meetings are held and records of the meeting show that suggestions (for example on the food served) have been acted upon. People who live in the home and their relatives are also formally surveyed by the service and the results of this survey will be published in the homes newsletter. Staff are also formally Care Homes for Older People Page 22 of 26 Evidence: surveyed and regular staff meetings are held. Good systems are in place to ensure that peoples finances are safeguarded. We checked the records held for three people; two staff sign for each transaction, receipts are kept and the balance is checked every 3-4 weeks by managers. Records and balances checked on the day of the inspection were accurate. The fire alarm system was being serviced on the day of the inspection visit and records show that the system is tested weekly, along with emergency lighting. The fire risk assessment was last reviewed in June 2008 and staff have received statutory training in fire safety. Staff have also received training in moving and handling, infection control and in first aid. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2010) Commission for Social Care Inspection (CSCI). 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